Treatment of Sigmoid Diverticulitis
Publication Date: December 31, 2013
Last Updated: March 14, 2022
Recommendations
Medical Treatment of Acute Diverticulitis
Nonoperative treatment typically includes oral or intravenous antibiotics and diet modification. (1C)
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Image-guided percutaneous drainage is usually the most appropriate treatment for stable patients with large diverticular abscesses. (1B)
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Evaluation After Recovery From Acute Diverticulitis
After resolution of an episode of acute diverticulitis, the colon should typically be endoscopically evaluated to confirm the diagnosis, if this is a first episode or recent colonoscopy has not been performed. (1C)
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Elective Surgery for Acute Diverticulitis
The decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized. (1B)
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Elective colectomy should typically be considered after the patient recovers from an episode of complicated diverticulitis. (1B)
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Routine elective resection based on young age (<50 years) is no longer recommended. (1C)
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Emergency Surgery for Acute Diverticulitis
Urgent sigmoid colectomy is required for patients with diffuse peritonitis or for those in whom nonoperative management of acute diverticulitis fails. (1B)
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Following resection, the decision to restore bowel continuity must incorporate patient factors, intraoperative factors, and surgeon preference. (1C)
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In patients with purulent or feculent peritonitis, operative therapy without resection is generally not an appropriate alternative to colectomy. (1C)
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Technical Considerations
The extent of elective resection should include the entire sigmoid colon with margins of healthy colon and rectum. (1C)
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When expertise is available, the laparoscopic approach to elective colectomy for diverticulitis is preferred. (1A)
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A leak test of the colorectal anastomosis should be performed during surgery for sigmoid diverticulitis. (1C)
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Ureteral stents are used at the discretion of the surgeon. (2C)
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Oral mechanical bowel preparation is not required; however, the use of oral antibiotics may decrease surgical site infections after elective colon resection. (1B)
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Elective colectomy for diverticulitis may be performed by sparing the superior hemorrhoidal artery or according to cancer surgery principles. (1C)
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Recommendation Grading
Overview
Title
Treatment of Sigmoid Diverticulitis
Authoring Organization
American Society of Colon and Rectal Surgeons
Publication Month/Year
December 31, 2013
Last Updated Month/Year
January 9, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D004238 - Diverticulitis, D004240 - Diverticulum, D004241 - Diverticulum, Colon
Keywords
diverticulitis, diverticulosis, fistula